眼动脉灌注化疗在眼内晚期成视网膜细胞瘤化学减容中的应用  

The application of intraophthalmic artery perfusion chemotherapy in the chemoreduction of advanced intra-ocular retinoblastoma

作　　者：王亮 韩明磊 吴长华 王长凤 宋丹 李静 赵军阳[3] 郭磊 WANG Liang;HAN Minglei;WU Changhua;WANG Changfeng;SONG Dan;LI Jing;ZHAO Junyang;GUO Lei(Department of Vascular Anomalies and Interventional Radiology,Qilu Children’s Hospital of Shandong University,Jinan,Shandong Province 250022,China)

机构地区：[1]山东大学齐鲁儿童医院血管瘤科和介入医学科,济南250022 [2]山东大学齐鲁儿童医院眼科,济南250022 [3]首都医科大学附属北京儿童医院眼科

出　　处：《介入放射学杂志》2020年第7期680-685,共6页Journal of Interventional Radiology

摘　　要：目的经导管眼动脉灌注化疗(IAC)为主体的化学减容治疗在眼内晚期成视网膜细胞瘤(D/E期)患儿有效性和安全性的短期观察。方法回顾性分析2016年9月至2017年12月收治的以IAC为主体进行化疗减容的眼内晚期成视网膜细胞瘤患儿102例,详细记录患儿性别、年龄、肿瘤分期、IAC途径(颈内动脉-眼动脉/颈外动脉-脑膜中动脉)、先后治疗经过、不良反应及预后情况。结果102例眼内晚期成视网膜细胞瘤患儿中单眼86例,双眼16例。共纳入研究106只患眼,合计D期68例,E期38例。共进行IAC治疗337眼次,总保眼率达84.9%,其中D期为85.3%,E期为84.2%。IAC术后出现的不良反应有眼睑肿胀2例、上睑下垂4例、额部红斑6例,玻璃体积血4例,视网膜脱离加重1例,眼球略内陷2例;此外,有10例出现不同程度的骨髓抑制,其中2例需要进行注射白细胞集落刺激因子治疗;6例患儿出现不同程度的呕吐,次数2~5次/d。中位随访时间为10个月,仅6例复发(D期4例,E期2例),其中1例经过局部治疗后稳定,1例再次行IAC后稳定,4例进行眼球摘除。结论眼动脉灌注化疗术为主体治疗的化学减容治疗可以有效提高患儿保眼率,缩短成视网膜细胞瘤患儿治疗周期,降低患儿不良反应。Objective To investigate the short-term efficacy and safety of chemoreduction with intraophthalmic artery chemotherapy(IAC)via catheter as the main therapeutic measure in treating advanced intra-ocular retinoblastoma(RB)of stage D/E in sick children.Methods The clinical data of a total of 102 sick children with advanced intra-ocular RB of stage D/E,who were admitted to the Qilu Children’s Hospital of Shandong University of China during the period from September 2016 to December 2017 to receive IAC-based chemoreduction,were retrospectively analyzed.The gender,age,tumor staging,IAC approach(via internal carotid artery-ophthalmic artery or via external carotid artery-middle meningeal artery),process of treatment,adverse events and prognosis were recorded in detail.Results Of the 102 sick child patients,unilateral RB was seen in 86 and bilateral RB in 16.A total of 106 diseased eyeballs were enrolled in this study,including68 eyeballs with stage D RB and 38 eyeballs with stage ERB.A total of 337 times of IAC treatment were accomplished.The total eyeball retention rate was 84.9%.The eyeball retention rate in patients with stage D RB was 85.3%and in patients with stage E RB was 84.2%.Post-IAC untoward effects included eyelid oedema(n=2),ptosis(n=4),forehead erythema(n=6),vitreous hemorrhage(n=4),worsened retinal detachment(n=1)and enophthalmos(n=2).Besides,different degrees of bone marrow suppression occurred in 10 patients.Among the 10 patients,2 had to receive injection of leukocyte colony-stimulating factor,and 6 developed different degrees of vomiting with the frequency of about 2-5 times/d.During the follow-up period for a median time of10 months,only 6 child patients had recurrence,including 4 patients of stage D and 2 patients of stage E.Among the 6 patients,the disease became stable after local treatment in one and after second IAC in another one,and in the remaining 4 the ophthalmectomy had to be carried out.Conclusion For the treatment of advanced intra-ocular RB of stage D/E in sick children,chemoreduction

关 键 词：成视网膜细胞瘤 经导管眼动脉灌注化疗术 化学减容 治疗 预后 

分 类 号：R445.3[医药卫生—影像医学与核医学]